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RN Jurisprudence Study Guide: Provincial Legislation

The RN Jurisprudence Examination uses a multiple-choice format that consists of a variety of questions that have been developed to assess the applicant’s competencies within three (3) categories: Regulatory Policies, relevant Federal Legislation, and relevant Provincial Legislation. Within each of these categories is a list of policies &/or legislation to be tested. To guide your study, each section includes a list of competencies, objectives, a synopsis of information and links to relevant resources.  This study guide is specific to provincial legislation.


Relevant Provincial Legislation

Competencies and Objectives (1 competency)

1. Practice in a manner consistent with relevant provincial legislation
Objective – the registered nurse will:

  • Define self-regulation
  • Define the difference between regulated and non-regulated professions
  • Identify the purpose of the Regulated Health Professions Network 

Synopsis of Information

Self-regulation is the relative autonomy by which a profession is practiced within the context of accountability to serve and protect the public interest.

Regulation is the act of controlling or directing according to rule or legislation. Regulation is the process of being regulated and in Nova Scotia; authoritative direction comes from the government. For example, midwives are not self-regulating in Nova Scotia; they are regulated by the government.

Non-regulated refers to individuals who are not regulated by a professional, governmental, or regulatory body. For example in health care, assistive personnel such as Continuing Care Assistants (CCAs) are unregulated. To be unregulated means there is no legislated authority or essential regulatory components such as a set of standards, a code of ethics or a process for conduct review; however, there is use of a provincial title and completion of a standard curriculum.

The Regulated Health Professions Network is comprised of health professionals such as nursing, physicians, physiotherapists and pharmacists, and used as a forum for communication, to share resources and expertise, collaborate on projects and identify common issues and concerns. Members voluntarily collaborate on regulatory processes related to the investigation of complaints, interpretation and/or modification of scopes of practice, and review of registration appeals. The network believes that health professionals working to their full scope of practice will further enhance access and health outcomes and eliminate statutory barriers to collaboration. There are currently more 23 regulated health professions, which are members of this network.

Resource Links:

Registered Nurses Act

Competencies and Objectives (8 competencies) 

1. Practise in a manner consistent with the Act governing nursing practice

Objective – the registered nurse will:

  • define the mandate of the College
  • define ‘practice of nursing’, ‘nursing services’ and scope of practice for LPNs, NPs and RNs
  • define the terms incapacity, incompetence, conduct unbecoming and professional misconduct 

Synopsis of Information 

The mandate of the College is to serve and protect the public interest, preserve the integrity of the nursing profession, and maintain public confidence in the ability of the nursing profession to regulate itself.

The College regulates the practice of nursing, advances and promote the practice of nursing, encourages members to participate in the affairs promoting the practice of nursing in the best interests of the public, and carries out other regulatory acts to achieve its legislated mandate.

The ‘practice of nursing’ means the application of specialized and evidence-based knowledge of nursing theory, health and human sciences, inclusive of principles of primary health care, in the provision of professional services to a broad array of clients ranging from stable or predictable to unstable or unpredictable, and includes:

(i) assessing the client to establish the client’s state of health and wellness,

(ii)identifying the nursing diagnosis based on the client assessment and analysis of all relevant data and information,

(iii) developing and implementing the nursing component of the client’s plan of care,

(iv) co-ordinating client care in collaboration with other health care disciplines,

(v) monitoring and adjusting the plan of care based on client responses,

(vi) evaluating the client’s outcomes,

(vii) such other roles, functions and accountabilities within the scope of practice of the profession that support client safety and quality care, in order to:

(A) promote, maintain or restore health,

(B) prevent illness and disease,

(C) manage acute illness,

(D) manage chronic disease,

(E) provide palliative care,

(F) provide rehabilitative care,

(G) provide guidance and counselling, and

(H) make referrals to other health care providers and community resources,

and also includes research, education, consultation, management, administration, regulation, policy or system development 

Incapacity means the status whereby a registrant respondent, at the time of the subject matter of a complaint or a report suffered from has or had a medical, physical, mental or emotional condition, disorder or addiction that rendered the respondent unable to practise with reasonable skill or judgment or that may have endangered the health or safety of clients.

Incompetence means the display of a lack of competence demonstrated in the registrant’s care knowledge, skill or judgment in the respondent’s care of a client or delivery of nursing services that, having regard to all the circumstances, rendered the respondent unsafe to practise at the time of such care of the client or delivery of nursing services or that renders the respondent unsafe to continue in practice without remedial assistance.

Conduct unbecoming means conduct in a member’s personal or private capacity that tends to bring discredit upon the nursing profession.

Professional misconduct includes such conduct or acts relevant to the profession that, having regard to all the circumstances would reasonably be regarded as disgraceful, dishonourable or unprofessional, that, without limiting the generality of the foregoing, may include:

(i) failing to maintain the standards of nursing practice or standards for nurse practitioners,

(ii) failing to uphold the code of ethics adopted by the College,

(iii) abusing a person verbally, physically, emotionally or sexually,

(iv) misappropriating personal property, drugs or other property belonging to a client or a member’s employer,

(v) inappropriately influencing a client to make or change a will or power of attorney,

(vi) wrongfully abandoning a client,

(vii) neglecting to provide care to a client,

(viii) failing to exercise appropriate discretion in respect of the disclosure of confidential information,

(ix) falsifying records,

(x) inappropriately using professional nursing status for personal gain,

(xi) promoting for personal gain any drug, device, treatment, procedure, product or service that is unnecessary, ineffective or unsafe,

(xii) publishing, or causing to be published, any advertisement that is false, fraudulent, deceptive or misleading,

(xiii) engaging or assisting in fraud, misrepresentation, deception or concealment of a material fact when applying for or securing registration or a licence to practise nursing or taking any examination provided for in this Act, including using fraudulently procured credentials, or

(xiv) taking or using the designation “registered nurse”, “nurse”, or any derivation or abbreviation thereof, or describing the person’s activities as “nursing” in any advertisement or publication, including business cards, websites or signage, unless the referenced activity falls within the definitions of the practice of nursing or the “practice of nurse practitioner” pursuant to this Act.

Resource Links:

2. Practise as directed within Part II: Registration and Licensing

Objectives – the registered nurse will:

  • describe the purpose of the CRNNS Register
  • describe the purpose and information contained in the CRNNS License Status Search
  • identify who is authorized use the designation registered nurse, R.N., RN, Reg. N.
  • identify who may describe their activities as “nursing”
  • identify what is required in order to engage in the practice of nursing
  • describe what is required to work out of province
  • identify the circumstances for which a temporary license may be issued and the related restrictions

Synopsis of Information 

CRNNS Register and License Status Check

The CRNNS Register is available to the public. It contains the following information for each member:

(a)    a unique registration number;

(b)    the name and location of the school of nursing attended;

(c)    the year the member graduated from the school of nursing;

(d)    the date of entry in the Register.

The Licence Status Check found on the CRNNS website includes the name and registration number of all registered nurses who are licensed to practice in Nova Scotia.

Use of RN Designation

No person shall take or use the designation “Registered Nurse”, “R.N.”, “RN” or “Reg. N.” in the Province, either alone or in combination with other words, letters or descriptions to imply that the person is entitled to practise as a registered nurse, unless that person is the holder of an active-practising licence or a transitional licence, with or without conditions or restrictions. 

Who can describe their Activities as ‘Nursing?’

No person shall take or use the designation “Nurse” or “nurse” or any derivation or abbreviation of the term, or describe their activities as “nursing” unless they are:

(a) a registered nurse;

(b) a holder of a temporary licence with or without restrictions or conditions;

(c) a licensed practical nurse or a graduate practical nurse pursuant to the Licensed Practical Nurses Act;

(d) a student enrolled in a nursing education program or a graduate or other nursing program recognized by Council, and is authorized by the administrators of the program, or otherwise authorized pursuant to the regulations, to engage in the practice of nursing;

(e) a student enrolled in a practical nursing education program approved by the College of Licensed Practical Nurses of Nova Scotia and is authorized by the administrators of the program to engage in the practice of practical nursing pursuant to the Licensed Practical Nurses Act; or

(f) a person whose name appears on the Certified Graduate Nurses List, maintained by CRNNS naming persons who graduated from a nursing education program but who did not meet the requirements to qualify as a registered nurse. 

Requirements for Engaging in the Practice of Nursing

No one shall engage in the practice of nursing in Nova Scotia unless:

(a) their name is entered in the Register and in the roster of active-practising members or transitional licences, with or without conditions or restrictions, and they are the holder of an active-practising licence or a transitional licence, with or without restrictions;

(b) they are the holder of a temporary licence;

(c) they are a student enrolled in a nursing education program or a nurse practitioner program and is authorized by the administrators of that program to engage in the practice of nursing as part of that program;

(d) they are a student enrolled in any other nursing program meeting criteria approved by the Education Advisory Committee, authorizing the student to engage in the practice of nursing as part of such program; or

(e) they are permitted to engage in the practice of nursing as otherwise provided in the Act or the Regulations.

Engaging in Practice outside of Nova Scotia

It is important to be aware of the following:

  • an RN engaging in practice by electronic means with clients living outside of Nova Scotia is deemed to be practising nursing in the province;
  • an RN, other than a CRNNS member, who resides outside of the province and engages in practice by electronic means with clients living in Nova Scotia is not deemed to be practising nursing in Nova Scotia;
  • nothing prohibits the practice of nursing in Nova Scotia or the recovery of fees or compensation for professional services rendered as a registered nurse by a person registered in another country, state, territory or province and whose engagement requires that person to accompany and temporarily care for a client during the period of the engagement, if that person does not represent or hold himself or herself out as a person registered with CRNNS.

If an RN wants to practise outside Nova Scotia, it is up to them to contact the regulatory body in the jurisdiction where they are planning to work to determine the requirements for registration and licensure. 

Temporary Licence

  1. The following individuals may be issued a temporary licence with or without conditions and restrictions:
    1. graduates from NS and other Canadian jurisdictions who have completed all nursing program requirements but have not passed the NCLEX-RN; or
    2. graduates from a nursing program completed in jurisdictions outside of Canada who are deemed by the CRNNS to be eligible to take but have not passed the NCLEX-RN.
  2. To obtain a temporary licence, individuals must:
    1. submit a complete application to the CRNNS; and
    2. pass the jurisprudence exam
  3. Each temporary licence will be issued with conditions and restrictions which will include but may not be limited to the following:
    1. must work with an identified RN who:
      1. has a minimum of 12 months experience; and
      2. is physically onsite in the care area (unit or facility);
      3. iii. will provide assistance, consultation and guidance; and
      4. is responsible to review the client assessment before the temporary licence holder initiates a care directive.
    2. cannot be the nurse in charge of the care area (facility or unit).
    3. cannot perform delegated functions.
    4. For Canadian graduates from outside Nova Scotia: within 1 business day must notify the CRNNS in writing of their NCLEX-RN exam results.
  4. Each temporary licence will be issued with an expiry date of four months.

Resource Links: 

3. Practise as directed within Part III of the RN Act: Professional Conduct

Objective – the registered nurse will:

  • identify four statutory committees that relate to the professional conduct of registered nurses 

Synopsis of Information 

According to the Registered Nurses Act, the CRNNS is required to establish statutory committees to carry out the essential functions related to its regulatory mandate. The statutory committees related to professional conduct are: Complaints Committee, Professional Conduct Committee, Fitness to Practice Committee and Reinstatement Committee.

Complaints Committee: The Complaints Committee is made up of volunteers comprised of RNs and members of the public. The Committee is in place to address and resolve complaints received by CRNNS that have been directed to them by the Executive Director. Committee members review the information and determine if there is enough evidence to come to a finding of professional misconduct, incompetence, incapacity and/or conduct unbecoming the profession.

Professional Conduct Committee: The Professional Conduct Committee is made up of RNs and members of the public who come together to make decisions about complaints forwarded by the Complaints Committee. These volunteers review the information and accept, reject, or suggest amendments to settlement proposals; prepare for and attend formal hearings; and make determinations of professional misconduct, incompetence, incapacity and/or conduct unbecoming the profession.

Fitness to Practise Committee: This Committee is made up of RNs and members of the public who contribute to public protection by reviewing, approving, revising or rejecting remedial agreements between members and CRNNS Professional Conduct.

Reinstatement Committee (Council members only): Reinstatement is for former CRNNS registrants who did not renew their registration by Oct. 31st or had their registration terminated. The Reinstatement Committee is made up of members of the CRNNS Council whose purpose it is to consider applications and make decisions for those wishing to reinstate their licence to practice nursing in Nova Scotia.

Resource Links:

4. Practices as directed within Part IV of the RN Act: Nurse Practitioners

Objectives – the registered nurse will:

  • determine who may use the designation nurse practitioner, N.P., NP
  • explain accountability for client records when self-employed nurses leave their practice 

Synopsis of Information

According to the Registered Nurses Act (Part IV, section 60), no person can take or use the designation ‘nurse practitioner, N.P., NP’ to imply that they are entitled to practice as a nurse practitioner, unless they hold an NP licence or a temporary NP licence with or without conditions or restrictions.

As well as NPs, self-employed registered nurses must be aware of the Registered Nurses Act (Part IV, section 63) where it states that self-employed registered nurses must make adequate provisions for client records. Where adequate provision has not been made for the protection of the client’s interests, the CRNNS may request the court to appoint a custodian to take possession of the client records as in the case of the unexpected death of a self-employed registered nurse. 

Resource Links:

 

Registered Nurses Regulations

Competencies and Objectives (5 competencies) 

1. Practise in a manner consistent with the regulations governing nursing practice

Objectives – the registered nurse will:

  • define the terms competencies, and competent
  • define the terms caution

Synopsis of Information

According to the RN Regulations (2009):

  • Competencies means the specific knowledge, skills and judgment required for a registered nurse or nurse practitioner to be considered competent in a designated role and practice setting.
  • Competent means the ability to integrate and apply the knowledge skills and judgment required to practice safely and ethically in a designated role and practice setting.
  • Caution means a determination by the Complaints Committee that a member has breached the standards of professional ethics or practice expected of members in circumstances that do not constitute professional misconduct, conduct unbecoming, incompetence or incapacity, and a caution is not considered to be a licensing sanction.

Resource links:

2. Practise as directed within Part II of the Regulations: Registration, Licensing and Membership

Objectives – the registered nurse will:

  • explain the difference between an active-practicing and temporary licences
  • define the term roster and list the ten CRNNS rosters
  • list the criteria required in order to enter the active-practising roster
  • explain how licences can be issued without completion of CCP

Synopsis of Information

Difference between Active-practicing and Temporary Licence

Only those individuals who hold an active-practicing licence are entered into the Register and entitled to use the designation registered nurse. A holder of a temporary licence is not entered into the Register and may only use the designation nurse. A temporary licence is issued for a limited period of time, which is usually less than one year in total. 

Definition and List of Rosters

Roster means the record of the category of licensing established pursuant to this Act or the regulations. There are ten rosters; one for each category of licence:

The following are the categories of licences under the Act:

  1. active-practising;
  2. active-practising with conditions or restrictions;
  3. transitional;
  4. transitional with conditions or restrictions;
  5. temporary;
  6. temporary with conditions or restrictions;
  7. nurse practitioner;
  8. nurse practitioner with conditions or restrictions;
  9. temporary (nurse practitioner);
  10. temporary (nurse practitioner) with conditions or restrictions. 

Entry Criteria for the Active-practicing Roster

In order to be entered on the active-practising roster, a member must:

  • pay the licence fee
  • not be currently subject to any disciplinary finding that would prohibit the practice of nursing
  • not currently under investigation by any registration or licensing authority
  • provide required information to establish that they have the capacity, competence, capability and character to safely and ethically practise nursing
  • provide required information to establish that they have no criminal convictions pursuant to Section 43 of the RN Act
  • complete the requirements of a continuing competence program
  • meet the requirements for nursing education program completion or practice hours. See Section 10 of the RN Regulations for details

Issuing Licence prior to Completion of Continuing Competence Program (CCP)

Applicants who satisfy all criteria for entry into a licensing roster, other than the requirements of a continuing competence program, may be entered into the licensing roster for no more than 3 consecutive months to give them time to complete the continuing competence program requirements.

Resource link:

3. Practise as directed within Part III of the Regulations: Records and Audit of Records

Objective – the registered nurse will:

  • state why a valid record of hours must be kept for previous 5 years

Synopsis of Information 

CRNNS requires a specific number of nursing practice hours in the previous five years and may and, at any time, may conduct an audit of members’ hours recorded on their licensure application. A member must complete at least 1125 hours in the 5 years prior to their application or 450 hours in the year immediately prior to their application. 

Resource link:

4. Practise as directed within Part IV of the Regulations: Committees

Objective – the registered nurse will:

  • define the role of Educational Advisory Committee in nursing education program approval 

Synopsis of Information

Education Advisory Committee: All nursing programs in Nova Scotia are approved by CRNNS through appointed members of the Education Advisory Committee (EAC). EAC committee members advise and make recommendations to Council about entry level nursing programs, nurse practitioner programs and nursing re-entry programs. The Committee makes recommendations on the standards for approval, the frequency of program review, and the approval status for these programs. 

Resource link:

5. Practise as directed within Part V of the Regulations: Professional Conduct

Objectives – the registered nurse will:

  • describe the sanctions that can be applied to a registered nurse’s licence through the professional conduct process
  • explain the eligibility criteria and process for the fitness to practice option in the professional conduct process

Synopsis of Information 

Professional Conduct Process: Sanctions

Once an investigation is complete and the nurse has had an opportunity to respond to the allegations, the matter will be reviewed to determine whether it should be forwarded to a professional conduct committee for further action or decision. Our professional conduct committees are made up of RNs, NPs and members of the public and each committee has a specific role in the professional conduct process.

Some minor matters may be resolved by staff, but most investigations are referred to the Complaints Committee. The Complaints Committee has the ability to resolve complaints in a variety of ways, but in more serious cases, the Complaints Committee will refer the allegations to the Professional Conduct Committee for a hearing.  The Professional Conduct Committee will receive the evidence and determine whether the allegations against the nurse are true, and if so, whether proven facts amount to a finding of misconduct, incompetence, incapacity and/or conduct unbecoming. If the Professional Conduct

Committee makes one or more of these findings, it must then decide on the appropriate penalty. Typical sanctions include:

  • a suspension of the nurse’s licence for a period of time
  • conditions on the nurse’s licence, such as a requirement to complete specified health treatment
  • restrictions on the nurse’s licence, preventing the nurse from working in certain practice areas
  • revocation of the nurse’s licence and registration

Professional Conduct Process: Fitness to Practice

According to the RN Act (2006), where a complaint involves allegations of incapacity, or where a member, in the absence of a complaint, discloses to the College that a member may be incapacitated, the Executive Director may refer the matter to the Fitness to Practise Committee in accordance with the RN Regulations (2009). Incapacity allegations that are not referred to FTP will be processed through the established complaint and investigation processes.

Registered nurses enter the Fitness to Practise process in one of two ways:

  1. Self-referral – Registered nurses seeking to enter the Fitness to Practise process.
  2. CRNNS referral – Registered nurses are referred by CRNNS following receipt of a complaint or upon receipt of information from a third party.

Generally, unless considered ineligible under the criteria identified below, eligible registered nurses are those who:

  • are licensed with the College of Registered Nurses of Nova Scotia or were licensed at the time of the matter giving rise to the referral;
  • are or have been incapacitated to the extent that their nursing practise may be affected;
  • voluntarily agree to enter the program and undergo any assessments requested by the executive director;
  • demonstrate a willingness to participate in timely remediation; and
  • comply with any direction to temporarily give up their licence to practise nursing or have conditions and/or restrictions applied to their licence pending resolution of the matter.

The registered nurses who are ineligible are those who have an incapacity that cannot reasonably be expected to be successfully treated or remedied or where the Executive Director or delegate believes that based on factors such as the nature and extent of the incapacity and/or the relapse history, the member is unlikely to successfully pursue any required remediation or treatment. This includes those registered nurses who:

  • failed to meet the terms and conditions of a previous remedial agreement or similar arrangement from another jurisdiction.
  • have other allegations or matters under investigation related to potential professional misconduct, incompetence or conduct unbecoming the profession that are not principally related to the incapacity;
  • have particular circumstances related to the matter where referral to Fitness to Practise would not be in the best interest of the public and/or the profession or would not be consistent with the objects of the Act.

FTP Process

At any time before, during or after an investigation, a matter may be referred to the Fitness to Practise program (FTP). These referrals are made if the complaint discloses a serious health issue about the nurse, which impacts the nurse’s ability to practice nursing. The referral may be sought by professional conduct services staff or by the nurse under investigation.

Once a referral is sought, the Director of Professional Conduct Services determines whether the nurse is eligible and should be accepted into the FTP program. In making this discretionary decision, the Director refers to a set of eligibility criteria; key criteria include a consideration of whether the nurse is willing to undergo any assessments required by CRNNS.

If applicable, CRNNS and the nurse negotiate a remedial agreement setting out the precise terms of the nurse’s return to work, including restrictions and conditions that will apply to the nurse’s licence. The remedial agreement must be approved by the FTP Committee before becoming effective. Both the respondent nurse and a representative from CRNNS attend the meeting of the FTP Committee. The FTP Committee considers whether the proposed terms contained in the remedial agreement:

1) ensure the best interests of the public are being met;

2) preserves the integrity of the nursing profession; and

3) maintains public confidence in the ability of the nursing profession to regulate itself.

The final decision of the FTP Committee is typically provided to the nurse, the complainant, relevant care providers, and the nurse’s employer(s). Any licensing restrictions or conditions are provided to others on request. The FTP Committee’s written decision and the remedial agreement are generally not made public.

Resource Links:

Adult Protection Act

Competencies and Objectives (1 competency)

  1. Practise in a manner consistent with the Adult Protection Act that directly governs nursing practice

Objectives – the registered nurse will:

  • define the term adult in need of protection
  • identify the requirement of a registered nurse to report that an adult is in need of protection
  • identify the consequence of failing to report an adult is need of protection 

Synopsis of Information

The purpose of the Adult Protection Act is to provide a means where adults who lack the ability to care and fend for themselves adequately, can be protected from abuse and neglect and provided with access to services. Under the Adult Protection Act, an adult is defined as a person who is sixteen years of age or older.

An “adult in need of protection” means an adult who, in the premises where he resides:

(i) is a victim of physical abuse, sexual abuse, mental cruelty or a combination thereof, is incapable of protecting himself there from by reason of physical disability or mental infirmity, and refuses, delays or is unable to make provision for his protection therefrom,

or

(ii) is not receiving adequate care and attention, is incapable of caring adequately for himself by reason of physical disability or mental infirmity, and refuses, delays or is unable to make provision for his adequate care and attention;

If an adult is in need of protection, everyone has a duty to report information, whether confidential or privileged, to the Minister of Community Services. Registered nurses would generally follow agency policy in how to report an adult in need of protection. No action can be taken against a person reporting abuse unless the information was given with malicious intent or without reasonable cause.

Individuals who fail to report information about an adult in need of protection are guilty of an offence under the Adult Protection Act.

Resource Links:

 

Children and Family Services Act

Competencies and Objectives (1 competency)

  1. Practise in a manner consistent with the Children and Family Services Act that directly governs nursing practice

Objectives – the registered nurse will:

  • define the circumstances for which a child is considered to be in need of protection
  • recognize the duty to report when a child is in need of protective services
  • identify process for parental/guardian refusal to consent to required medical care. 

Synopsis of Information

Within the Children and Family Services Act, the term ‘child’ means a person under sixteen years of age unless the context otherwise requires a different age.

Circumstances Requiring Protective Services

According to the Children and Family Services Act, a child is in need of protective services where:

(a) the child has suffered physical harm, inflicted by a parent or guardian of the child or caused by the failure of a parent or guardian to supervise and protect the child adequately;

(b) there is a substantial risk that the child will suffer physical harm inflicted or caused as described in clause (a);

(c) the child has been sexually abused by a parent or guardian of the child, or by another person where a parent or guardian of the child knows or should know of the possibility of sexual abuse and fails to protect the child;

(d) there is a substantial risk that the child will be sexually abused as described in clause (c);

(e) a child requires medical treatment to cure, prevent or alleviate physical harm or suffering, and the child’s parent or guardian does not provide, or refuses or is unavailable or is unable to consent to, the treatment;

(f) the child has suffered emotional harm, demonstrated by severe anxiety, depression, withdrawal, or self-destructive or aggressive behaviour and the child’s parent or guardian does not provide, or refuses or is unavailable or unable to consent to, services or treatment to remedy or alleviate the harm;

(g) there is a substantial risk that the child will suffer emotional harm of the kind described in clause (f), and the parent or guardian does not provide, or refuses or is unavailable or unable to consent to, services or treatment to remedy or alleviate the harm;

(h) the child suffers from a mental, emotional or developmental condition that, if not remedied, could seriously impair the child’s development and the child’s parent or guardian does not provide, or refuses or is unavailable or unable to consent to, services or treatment to remedy or alleviate the condition;

(i) the child has suffered physical or emotional harm caused by being exposed to repeated domestic violence by or towards a parent or guardian of the child, and the child’s parent or guardian fails or refuses to obtain services or treatment to remedy or alleviate the violence;

(j) the child has suffered physical harm caused by chronic and serious neglect by a parent or guardian of the child, and the parent or guardian does not provide, or refuses or is unavailable or unable to consent to, services or treatment to remedy or alleviate the harm;

(ja) there is a substantial risk that the child will suffer physical harm inflicted or caused as described in clause (j);

(k) the child has been abandoned, the child’s only parent or guardian has died or is unavailable to exercise custodial rights over the child and has not made adequate provisions for the child’s care and custody, or the child is in the care of an agency or another person and the parent or guardian of the child refuses or is unable or unwilling to resume the child’s care and custody;

(l) the child is under twelve years of age and has killed or seriously injured another person or caused serious damage to another person’s property, and services or treatment are necessary to prevent a recurrence and a parent or guardian of the child does not provide, or refuses or is unavailable or unable to consent to, the necessary services or treatment;

(m) the child is under twelve years of age and has on more than one occasion injured another person or caused loss or damage to another person’s property, with the encouragement of a parent or guardian of the child or because of the parent or guardian’s failure or inability to supervise the child adequately.

Duty to Report

Every person who has information, whether or not it is confidential or privileged, indicating that a child is in need of protective services shall report that information to an agency, which includes the Minister of Community Services. No action will be taken against a person if reporting information, unless it is done falsely and maliciously. Every person who fails to report or reports false or malicious information is guilty of an offence and upon summary conviction is liable to a fine or imprisonment.

Refusal to Consent to Medical Treatment

Where a child’s parent or guardian refuses to consent to the provision of proper medical or other recognized remedial care or treatment that is considered essential by two duly qualified medical practitioners, the Minister is notified and shall apply to the court for a hearing.

Resource Links

Coordinated Home Care Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Coordinated Home Care Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Define the services provided through the Coordinated Home Care Program
  • Define the role of the Continuing Care Assessor
  • Identify the elements of home care nursing services provided by the registered nurse 

Synopsis of Information

According to the Coordinated Home Care Act, the “Coordinated Home Care Program” means the coordinated delivery of a range of health, housing and social services to meet the needs of persons who require assistance or support in order to remain in their own homes or community or whose functioning without assistance or support is likely to deteriorate, making it impossible to stay in their own homes or community.

Case Management

The NS Department of Health and Wellness – Co-ordinated Home Care Policies define case management to include assessment, service planning, care coordination, and monitoring and evaluation of the effectiveness of the service plan. Case management is a collaborative, client-centred process that is continuous across provider and agency lines. Case management addresses the health and well-being of clients, while promoting quality care and cost effective outcomes.

Continuing Care Assessor Role

A continuing care assessor is an NSHA staff person who completes an assessment of the applicant/client to determine program eligibility and need for home care services. The NSHA is required to provide case management for home care clients. Case management develops an approach that improves access to coordinated and integrated health services that are client-centered, community based and meet the client’s health needs. As part of the case management process, registered nurses who are employed in the role of Continuing Care Assessors facilitate and coordinate services, timely and appropriate access to services and provide ongoing assessments.

Home support services include personal care, meal preparation, light housekeeping and respite. Home support service providers must be supervised, either directly or indirectly, by a licensed RN or LPN.

Home care nursing services must be delivered by registered nurses or licensed practical nurses. These nursing services include: performing nursing assessments, treatments and procedures; teaching and supervising self-care to clients receiving personal care; teaching personal care to family and other caregivers; supervising home support service providers; providing personal care as identified by the assessment process and initiating referrals to other agencies.

Resource Links:

Fatality Investigations Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Fatality Investigations Act that directly governs nursing practice

Objectives – the registered nurse will:

  • List the circumstances that require immediate notification of the medical examiner
  • List the circumstances when a medical examiner may authorize an autopsy of
  • Identify when to notify the medical examiner can authorize the removal or organs or tissues 

Synopsis of Information

Duty to Notify of Death

According to section 9 of the Fatality Investigations Act, anyone having knowledge of or reason to believe that a person has died under one of the following circumstances shall immediately notify a medical examiner or an investigator:

  1. as a result of violence, accident or suicide;
  2. unexpectedly when the person was in good health;
  3. where the person was not under the care of a physician;
  4. where the cause of death is undetermined; or
  5. as the result of improper or suspected negligent treatment by a person. 

Death in a Health-care Facility

According to section 10 of the Fatality Investigations Act, where a person dies while in a health-care facility and there is reason to believe that:

  1. the death occurred as the result of violence, suspected suicide or accident;
  2. the death occurred as a result of suspected misadventure, negligence or accident on the part of the attending physician or staff;
  3. the cause of death is undetermined;
  4. a stillbirth or a neonatal death has occurred where maternal injury is confirmed or suspected either before admission or during delivery; or
  5. the death occurred within ten days of an operative procedure or under initial induction, anaesthesia or the recovery from anaesthesia from that operative procedure,

the person responsible for that facility shall immediately notify a medical examiner or an investigator.

In addition, where a person is declared dead on arrival or dies in the emergency department of a health-care facility as a result of a circumstance listed above, the person responsible for that facility shall immediately notify a medical examiner or an investigator.

Death in Custody or Detention

According to section 11 of the Fatality Investigations Act, where a person dies:

  1. while detained or in custody in a correctional institution such as a jail, penitentiary, guard room, remand centre, detention centre, youth facility, lock-up or any other place where a person is in custody or detention;
  2. while an inmate who is in a hospital or a facility as defined in the Hospitals Act;
  3. in an institution designated in the regulations;
  4. while in the custody of the Minister of Community Services pursuant to the Children and Family Services Act; or
  5. while detained by or in the custody of a peace officer or as a result of the use of force by a peace officer while on duty,

the person in charge of that institution or the person detaining or having the custody of the deceased person shall immediately notify a medical examiner or an investigator. 

In addition, where a person dies while committed to a facility or institution as listed above but while not on the premises or in actual custody, the person in charge of that facility or institution, jail or other place shall, immediately on receiving notice of the death, notify a medical examiner.

Death Probably Related to Employment or Occupation

According to section 12 of the Fatality Investigations Act, where a person dies as the result of

  1. a disease or ill health;
  2. an injury sustained by the person; or
  3. a toxic substance introduced into the person,

probably caused by or connected with the person’s employment or occupation, the physician attending the deceased person at the time of that person’s death shall immediately notify a medical examiner or an investigator.

Autopsy

A medical examiner may authorize the autopsy of the body of a person who died under a circumstance referred to in Sections 9 to 12 of the Fatality Investigations Act (2014) as noted above. Where a medical examiner authorizes an autopsy, the autopsy shall be carried out by a pathologist. A person who performs an autopsy shall provide the medical examiner with the autopsy reports.

Removal of Organs or Tissues

According to section 14 of the Fatality Investigations Act (2014), where the removal of the tissue or organs does not interfere with an investigation or proceeding, and appropriate consent has been obtained under the Human Tissue Gift Act, a medical examiner may remove or allow the removal of organs or tissues for therapeutic, medical education or scientific research.

In addition, where a person has been declared legally dead but where that person’s organ functions are sustained by artificial means, and the appropriate consent has been given under the Human Tissue Gift Act for live organ donation, the medical examiner shall be notified and shall determine whether the removal of those tissues or organs will interfere with an investigation or proceeding.

Resource Links:

Gunshot Wounds Mandatory Reporting Act

Competencies and Objectives (1 competency)

  1. Practise in a manner consistent with the Gunshot Wounds Mandatory Reporting Act that directly governs nursing practice

Objective – the registered nurse will:

  • identify when a gunshot wound inflicted on an individual is to be disclosed to the police.

Synopsis of Information

According to section 3 of the Gunshot Wounds Mandatory Reporting Act, every hospital, facility or service that treats an individual for a gunshot wound shall disclose to the local police service:

  1. the fact that an individual is being treated, or has been treated, for a gunshot wound;
  2. the individual’s name, if known; and
  3. the name and location of the hospital, facility or service.

This applies whether or not the treatment by an employee (e.g. an RN) of a hospital, facility or service takes place at the premises of the hospital, facility or service. The disclosure required must be made orally by the prescribed person as soon as it is reasonably practical to do so without interfering with the individual’s treatment or disrupting the regular activities of the hospital, facility or service. 

Resource Links:

Health Protection Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Health Protection Act that directly governs nursing practice

Objectives – the registered nurse will:

  • describe the role of the public health nurse
  • define who can be designated as a public health nurse
  • identify who may be delegated the powers, duties and functions of Chief Medical Officer
  • Identify specific diseases that must be reported the Medical Officer of Health 

Synopsis of Information

Public Health Nurse (PHN)

Under the Health Protection Act, a public health nurse means a public health nurse employed by a health authority, or any other individual designated as a public health nurse by the Minister. A public health nurse must be a duly qualified registered nurse. The Minister can designate a public health nurse from among employees in the public service of the province or employees of the Government of Canada or the government of another province of Canada. The Minister sets the qualifications, skills, and standards required for designation.

Roles and Responsibilities

A public health nurse:

  • Has immunity for performance of any duty or any power exercised under the Health Protection Act (2004) that has been exercised in good faith.
  • Assists the MOH in enforcing the act and regulations.
  • May be responsible for monitoring a person named in an order and reporting their condition to the medical officer of health.
  • Who is investigating a suspected case of a communicable disease or exposure to a health hazard, has the same power as a MOH to enter any premises other than a dwelling at a reasonable time in order to inspect, investigate, examine, test, analyze, or inquire
    • enter a dwelling with consent
    • require any person to provide the public health nurse with personal information including personal information or business information or to produce records or documents
    • copy the information or take it to copy and retain as evidence
  • Can call for assistance from any constable, police officer, or peace officer.

Under section 9 of the Health Protection Act, the Chief Medical Officer may delegate any of the powers, duties or functions of the office to the Deputy Chief Medical Officer, a medical officer, a public health nurse or a public health inspector.

In section 31 of the Health Protection Act – Notifiable Diseases or Conditions, a registered nurse who has reasonable grounds to believe that a person has or may have a notifiable disease or condition must report that belief to a medical officer of health. Diseases that must be reported can be found in Appendix A of A Guide to the Health Protection Act & Regulations.  The list of guidance documents related to the Health Protection Act and Regulations can be found in Appendix B.

Resource Links:

Homes for Special Care Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Home for Special Care Act that directly governs nursing practice

Objectives – The registered nurse will:

  • Identify the differences between a nursing home and a residential care facility
  • Describe specific criteria for admission to a LTC facility or Residential care facility
  • Describe nurse staffing requirements in different types of nursing homes/homes for special care
  • Describe specific aspects of the regulations that pertain to storage of drugs
  • Identify the information to be recorded on a resident’s medication record
  • Explain the processes that must be followed related to medication orders
  • Identify the process for medication reviews

 Synopsis of Information

According to the Homes for Special Care Regulations: 

Home for special care means a nursing home, a home for the aged, a home for the disabled, and a residential care facility.

Community based residential facility means any building or place where persons receive supervisory care in a residential and family environment and the care is provided by persons who are not their parents, and includes all of the following:

(a)    a group home;

(b)    a developmental residence;

(c)    a small option home.

Specific Criteria for Admission to a LTC Facility or Residential Care Facility

Unless the Minister otherwise orders:

  • no person who requires nursing care may be admitted to or maintained in a residential care facility
  • no person who requires hospital care shall be admitted to or maintained in a home for special care

A residential care facility may provide supervisory care and personal care to the persons admitted to and maintained in the facility.

A home for the aged and a home for the disabled may provide supervisory care, personal care and nursing care to persons admitted to and maintained in the home, provided however that:

(a)    those persons who require nursing care shall be maintained in a section of the home which complies with all of the requirements of the Act and these regulations which relate to nursing homes except those requirements that deal with licensing; and

(b)    the section of the home in which persons who require supervisory or personal care are maintained complies with all the requirements of the Act and these regulations which relate to residential care facilities except those requirements which deal with licensing.

The Administrator of the home for special care shall take whatever action is necessary to remove from the home any resident who, in the opinion of the inspector, is not a suitable person to be maintained in the home, and shall take whatever steps are necessary to place the resident in the type of accommodation recommended by the inspector.

Nurse Staffing Requirements

According to section 18 of the Homes for Special Care Regulations, every nursing home and nursing care section of a home for special care where there are less than 30 residents, there must be at least one registered nurse on duty for no less than eight hours every day, and in the absence of the registered nurse, there shall be a person on duty in the home who is capable of providing emergency care.

In every nursing home and nursing care section of a home for the aged where there are 30 or more residents, there must be at least one registered nurse on duty at all times.

In every residential care facility other than a small option home, there must be a staff member who is capable of providing necessary emergency care on duty in the home at all times.

Storage of Drugs

According to section 38 of the regulations, all drugs in a home for special care must be stored in a separate storage area.

The storage area for drugs shall be kept locked at all times and only the pharmacist for the home, the administrator of the home and persons authorized by the administrator shall have access to the drug storage area. Temperature and lighting in the storage area must be appropriate for the drugs being stored.

Special care homes licensed by either the Minister of Health and Wellness or the Minister of Community Services can authorize the storage of drugs in a resident’s room when:

  1. the resident’s individualized plan contains a written clinical assessment authorizing the storage;
  2. the requirements set out in policy and standards for the home are met

Medication Records

The medication record for each resident of a home for special care must include the resident’s name, address, age, sex, weight, food and drug sensitivities and allergies; the type and dosage of drug; the manner in which the drug is to be administered; the physician who prescribed the drug; the date of the prescription and the date of discontinuance.

Medication Orders

According to section 41 of the regulations, all orders for medication must be in writing and must be signed by a physician, a nurse practitioner, or a pharmacist (if appropriate protocols have been established for the pharmacist).

Exceptions exist in the following situations:

  1. In a home for special care where a registered nurse is on duty, the registered nurse may accept a verbal order for medication from a physician, a nurse practitioner, or a pharmacist in an emergency or when the medication does not require a prescription.
  2. In a home for special care where a registered nurse is not required to be on duty, the administrator, or a person designated by the administrator who is qualified to administer medications in the facility, may accept a verbal order for medication from a physician, a nurse practitioner, or a pharmacist in an emergency or when the medication does not require a prescription.

A verbal order for medication accepted under the two situations noted above must be in writing and signed by the physician, nurse practitioner or pharmacist who issued the verbal order no later than 72 hours after the verbal order was issued. 

Medication Record Reviews

According to section 43 of the regulations, in homes for special care licensed by the Minister of Health and Wellness, each medication received by a resident must be reviewed at least monthly to determine whether the medication should be discontinued or altered.

In homes licensed by the Minister of Community Services, each medication received by a resident must be reviewed based on the resident’s individual needs as assessed and recommended by a qualified medical practitioner, nurse practitioner or pharmacist.

The administrator of a home for special care is responsible for ensuring that a review is completed through consultation with a qualified medical practitioner, nurse practitioner or pharmacist. 

Resource Links:

Hospitals Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Hospitals Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Identify who may admit a patient to hospital in need of hospital services
  • Identify who may discharge a patient from hospital
  • Identify who can consent to required medical or surgical treatment when a person is unable to consent 

Synopsis of Information

Admitting Privileges

According to the Hospitals Act, physicians, midwives and dental practitioners have the authority to admit a patient in need of hospital services.

Discharge Privileges

According to the Hospitals Regulations, physicians, midwives, dental practitioners and nurse practitioners have the authority to discharge a patient from hospital services.  In addition, a physician may authorize a registered nurse to discharge a patient from a health authority facility in accordance with the facility’s bylaws.

 Consent by Substitute Decision-maker

According to the Hospitals Act, when a patient in a hospital or a psychiatric facility is found by declaration of capacity to be incapable of consenting to treatment, consent may be given or refused on behalf of the patient by a substitute decision-maker who has capacity and is willing to make the decision to give or refuse the consent from the following in descending order:

  1. a person who has been authorized to give consent under the Medical Consent Act or a delegate authorized under the Personal Directives Act;
  2. the patient’s guardian appointed by a court of competent jurisdiction;
  3. the spouse of the patient;
  4. an adult child of the patient;
  5. a parent of the patient;
  6. a person who stands in the place of a parent to the patient;
    1. an adult sibling of the patient;
    2. a grandparent of the patient;
    3. an adult grandchild of the patient;
    4. an adult aunt or uncle of the patient;
    5. an adult niece or nephew of the patient;
  7. any other adult next of kin of the patient; or
  8. the Public Trustee.

Resource Links:

Human Organ and Tissue Donation Act

Competencies and Objectives (1 competency)

  1. Practise in a manner consistent with the Human Organ and Tissue Donation Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Identify the health professional’s responsibility regarding organ and tissue donation
  • Identify the information that must be provided when an individual is consenting to post-mortem organ donation
  • Identify when consent to post-mortem organ donation may be voided
  • Identify how a donor may withdraw consent for donation
  • State whether or not human organs, tissue or body for use in transplantation, education or scientific research may be bought or sold. 

Synopsis of Information

Professional Responsibilities

The front line health provider’s role is to identify, refer, and document the organ and tissue donation process. Physicians and nurses are required to conduct an initial screening assessment for organ and tissue donation on all patients under their care who expire in a health facility in Nova Scotia. Required referral means that when a potential organ and tissue donor is identified by front line staff, a referral must be made to the organ and tissue donation programs.

Consent Information for Post-mortem Organ Donation

According to the Human Organ and Tissue Donation Act, the following information, at a minimum, must be provided to an individual or the individual’s substitute decision maker when the individual or the individual’s substitute decision maker is making a decision to give consent to donation after death for transplantation:

(a) an explanation of the donation process

(b) an explanation of the determination of death process;

(c) an explanation of pre-death transplantation optimizing interventions and why they are used, except in cases where the substitute decision maker is being asked for consent after the person has died;

(d) what organs or tissue can be donated;

(e) that by consenting to donation after death for transplantation, the individual or substitute decision maker authorizes the information sharing of the individual’s personal information between persons and organizations engaged in the donation, procurement or transplantation of organs and tissues for the purpose of facilitating organ and tissue donation and transplantation across jurisdictions; and

(f) an explanation of additional tests and procedures conducted to determine medical suitability and confidentiality protections and potential notification requirements regarding this information.

Withdrawal of Consent to Post-Mortem Organ Donation

According to the Act, a donor’s withdrawal of consent may be given in a writing signed by the donor or orally, in person or otherwise, in the presence of at least two witnesses with contemporaneous documentation of the withdrawal signed by two witnesses.

Voiding Consent to Post-Mortem Organ Donation

According to the Act, a donation after death cannot be used when:

(a) the donated body, organs or tissue are medically unsuitable;

(b) there is no need for the donated body, organs or tissue;

(c) all potential recipients are located too far away from the donated body, organs or tissue; or

(d) there is a lack of available resources,

the consent is void and the donated body, organs or tissue must be dealt with as if no consent had been given.

Purchase and Sale of Organs and Body Tissues

According to the act, no person in Nova Scotia can buy, sell, or otherwise deal in, directly or indirectly, for valuable consideration, any human organs, tissue, or body for use in transplantation, education or scientific research.

Resource Links:

Involuntary Psychiatric Treatment Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Involuntary Psychiatric Treatment Act that directly governs nursing practice

  • Objectives – the registered nurse will:
  • Define the terms voluntary and involuntary patient
  • Explain the requirements for detention of a voluntary patient admission
  • Explain the requirements for involuntarily patient admission
  • Identify who can act as a substitute decision maker on behalf of an involuntary patient

Synopsis of Information

Definitions

According to the Involuntary Psychiatric Treatment Act:

  • voluntary patient means a person who remains in a psychiatric facility with that person’s consent or the consent of a substitute decision-maker
  • involuntary patient means a patient who is admitted to a psychiatric facility pursuant to a declaration of involuntary admission

Detention of a Voluntary Patient

According to the Act, a member of the treatment staff of a psychiatric facility may detain and, where necessary, restrain a voluntary patient requesting to be discharged if the staff member believes on reasonable grounds that the patient

(a) has a mental disorder;

(b) because of the mental disorder, is likely to cause serious harm to himself or herself or to another person or to suffer serious impending mental or physical deterioration if the patient leaves the psychiatric facility; and

(c) needs to have a medical examination conducted by a physician.

A patient who is detained as noted above must be examined by a physician within three hours.

Involuntary Admission Requirements

According to the Act, a psychiatrist who has conducted an involuntary psychiatric assessment and is of the opinion that:

(a) the person has a mental disorder;

(b) the person is in need of the psychiatric treatment provided in a psychiatric facility;

(c) the person, as a result of the mental disorder,

(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so, or

(ii) is likely to suffer serious physical impairment or serious mental deterioration, or both;

(d) the person requires psychiatric treatment in a psychiatric facility and is not suitable for inpatient admission as a voluntary patient; and

(e) as a result of the mental disorder, the person does not have the capacity to make admission and treatment decisions,

the psychiatrist may admit the person as an involuntary patient by completing and filing with the chief executive officer a declaration of involuntary admission in the form prescribed by the regulations.

Consent by Substitute Decision Maker

According to the Act, consent may be given or refused on behalf of an involuntary patient or a patient on a community treatment order by a substitute decision-maker who has capacity and is willing to make the decision to give or refuse the consent from the following in descending order:

(a) a person who has been authorized to give consent under the Medical Consent Act;

(b) the involuntary patient’s guardian appointed by a court of competent jurisdiction;

(c) the spouse or common-law partner, if the spouse or common-law partner is cohabiting with the patient in a conjugal relationship;

(d) an adult child of the patient;

(e) a parent of the patient or a person who stands in loco parentis;

(f) an adult brother or sister of the patient;

(g) any other adult next of kin of the patient; or

(h) the Public Trustee.

If a valid substitute decision maker has been identified but refuses to give consent on the patient’s behalf, no other person listed in a subsequent category in the list above can provide consent. The psychiatrist is responsible for obtaining consent from the appropriate person referred to in the list above.

Resource Links:

Involuntary Psychiatric Treatment Act

Licensed Practical Nurses Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Licensed Practical Nurses Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Define the terms nursing services practice of practical nursing and the practice of nursing

Synopsis of Information 

Definition

According to the LPN Act (2006):

nursing services means the application of practical nursing theory in the assessment of clients, collaboration in the development of the nursing plan of care, implementation of the nursing plan of care, and ongoing evaluation of the client, for the purpose of

  1. promoting health,
  2. preventing illness,
  3. providing palliative and rehabilitative care, and
  4. assisting clients to achieve an optimal state of health.

practice of practical nursing means the provision of nursing services

  1. independently, for clients considered stable with predictable outcomes, and
  2. under the guidance or direction of a registered nurse, medical practitioner or other health care professional authorized to provide such consultation, guidance or direction, for clients considered unstable with unpredictable outcomes.

According to the RN Act (2006):

practice of nursing means the application of specialized and evidence-based knowledge of nursing theory, health and human sciences, inclusive of principles of primary health care, in the provision of professional services to a broad array of clients ranging from stable or predictable to unstable or unpredictable, and includes:

  1. assessing the client to establish the client’s state of health and wellness,
  2. identifying the nursing diagnosis based on the client assessment and analysis of all relevant data and information,
  3. developing and implementing the nursing component of the client’s plan of care,
  4. coordinating client care in collaboration with other health care disciplines,
  5. monitoring and adjusting the plan of care based on client responses,
  6. evaluating the client’s outcomes,
  7. such other roles, functions and accountabilities within the scope of practice of the profession that support client safety and quality care, in order to
    1. promote, maintain or restore health,
    2. prevent illness and disease,
    3. manage acute illness,
    4. manage chronic disease,
    5. provide palliative care,
    6. provide rehabilitative care,
    7. provide guidance and counselling, and
    8. make referrals to other health care providers and community resources,

and also includes research, education, consultation, management, administration, regulation, policy or system development.

Resource Links:

Occupational Health and Safety Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Occupational Health and Safety Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Describe shared responsibilities for the health and safety of persons at the workplace
  • List the precautions and duties employees’ must follow while at work
  • State when an employee may refuse to work
  • Identify duty to report incidents of violence
  • Identify investigation and documentation requirements for incidents of violence in the workplace

Synopsis of Information

Shared Responsibility for Workplace Health and Safety

According to the Occupational Health and Safety Act,  employers, contractors, constructors, employees, self-employed persons at a workplace, the owner of a workplace, a supplier of goods or provider of an occupational health or safety service to a workplace or an architect or professional engineer share in the responsibility for the health and safety of persons in the workplace.

 Employees Precautions and Duties

According to the Act, every employee, while at work, shall:

  1. take every reasonable precaution in the circumstances to protect the employee’s own health and safety and that of other persons at or near the workplace
  2. co-operate with the employer and with the employee’s fellow employees to protect the employee’s own health and safety and that of other persons at or near the workplace
  3. take every reasonable precaution in the circumstances to ensure that protective devices, equipment or clothing required by the employer, this Act or the regulations are used or worn
  4. consult and co-operate with the joint occupational health and safety committee, where such a committee has been established at the workplace, or the health and safety representative, where one has been selected at the workplace
  5. co-operate with any person performing a duty or exercising a power conferred by this Act or the regulations and
  6. comply with this Act and the regulations.

Where an employee believes that any condition, device, equipment, machine, material or thing or any aspect of the workplace is or may be dangerous to the employee’s health or safety or that of any other person at the workplace, the employee shall immediately report it to a supervisor. Where the matter is not remedied to the employee’s satisfaction, the nursing home must report it to the health and safety committee or the health and safety representative. If the matter is not remedied to the employee’s satisfaction after the employee reports, report it to the Occupation Health and Safety Division of the Department of Labour and Advanced Education.

A nurse may refuse to do any act at the employee’s place of employment where the nurse has reasonable grounds for believing that the act is likely to endanger the nurse’s health or safety or the health or safety of any other person.

As outlined in the Duty to Provide Care: Assignments in Relation to Competence Practice Guideline, if registered nurses determine they do not have the necessary competencies or physical, psychological or emo­tional well-being to provide safe and competent care, they may withdraw from the provision of care or refuse to provide care if they have given reasonable notice to their employer and appropriate action has been taken to replace them or resolve the issue.

A nurse who is considering refusing to provide care on the basis of a risk to their own health should be aware of the provisions of the Occupational Health and Safety Act that govern refusals to work and should consider seeking assistance from a union representative or the Canadian Nurses Protective Society.

As outlined in the Practice Guideline: Duty to Provide Care in Emergency Situations, while there is an expectation that registered nurses will provide care to the sick and absorb a certain amount of risk in doing so, there is not an expectation that registered nurses will place themselves at unnecessary risk during an emergency. There are situations in which it may be acceptable for registered nurses to withdraw or refuse care.

Duty to report incidents of violence

According to the Regulations, an employer, contractor, constructor, supplier, employee, owner or self-employed person in the workplace has a duty to report all incidents of violence in a workplace to the employer.

Documentation, investigation and actions to prevent reoccurrence

According to the Regulations, an employer must ensure that incidents of violence in a workplace are documented and promptly investigated to determine their causes and the actions needed to prevent reoccurrence.

In addition, an employer must ensure that notice of the actions taken to prevent reoccurrence of an incident of violence are given to any employee affected by the incident of violence, any committee established at the workplace, and any representative selected at the workplace.

Resource Links:

Personal Directives Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Personal Directives Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Define the terms capacity and delegate
  • Identify who is not eligible to be a delegate
  • Identify what is included in a personal directive
  • Identify what contributes to the validity of a personal directive
  • Explain when a delegate’s authority ceases under a personal directive
  • Explain when instructions in a personal directive need not be followed by a delegate when making decisions
  • Recognize accountability to determine whether or not a person has a personal directive
  • Identify what actions to take if a personal directive does or does not exist
  • Identify when a health care provider is not required to obtain consent from the delegate
  • Identify an acceptable alternative to a personal directive made under this Act
  • Explain what assessments of capacity may only be conducted by a physician

Synopsis of Information

Definitions

According to the Personal Directives Act:

  • capacity means the ability to understand information that is relevant to the making of a personal-care decision and the ability to appreciate the reasonably foreseeable consequences of a decision or lack of a decision.
  • delegate is a person authorized under a personal directive to make, on an individual’s behalf decisions concerning that individual’s personal care.

Who is not eligible to be a Delegate

A person may not act as a delegate for an individual under a personal directive if the person provides personal care services for that individual for compensation.

Personal Directive Information

A person with capacity may make a personal directive setting out instructions or an expression of the maker’s values, beliefs and wishes about future personal-care decisions to be made on his or her behalf; and authorizing one or more persons who, except in the case of a minor spouse, is or are of the age of majority to act as delegate to make, on the maker’s behalf, decisions concerning the maker’s personal care.

Validity of Personal Directive

A personal directive must be in writing, be dated and be signed by the maker or, where the maker is unable to sign, by a person who is not a delegate or the spouse of the delegate on behalf of the maker at the maker’s direction and in the maker’s presence, and in the presence of a witness who must also sign.

The signing of a personal directive must be witnessed by someone other than a delegate, a spouse of a delegate, a person who signs on behalf of the maker or the spouse of a person who signs on behalf of the maker.

Cessation of Delegate’s Authority

A delegate’s authority under a personal directive ceases when the delegate resigns, dies or lacks capacity to make personal-care decisions on behalf of the maker; when the maker revokes the delegate’s authority or on a determination by the court.

Delegate’s Criteria for not following a Personal Directive

In making any decision, a delegate shall follow any instructions in a personal directive unless:

  1. there were expressions of a contrary wish made subsequently by the maker who had capacity,
  2. technological changes or medical advances make the instruction inappropriate in a way that is contrary to the intentions of the maker, or
  3. circumstances exist that would have caused the maker to set out different instructions had the circumstances been known based on what the delegate knows of the values and beliefs of the maker and from any other written or oral instructions.

Provider Accountabilities to Confirm Existence of Personal Directive

Before seeking a decision of a statutory decision-maker in relation to a health care decision for a person, a health-care provider must inquire whether the person has made a personal directive.  If a personal directive exists, the health-care provider will request a copy of a personal directive and include it in the maker’s health record.

Actions to take if a personal directive does or does not exist

A health-care provider shall follow:

  1. any instructions by a delegate acting in accordance with the personal directive
  2. where there is no delegate, the instructions or an expression of the maker’s wishes contained in a personal directive; or
  3. where there is no applicable personal directive, any instructions by a statutory decision-maker acting in accordance with this Act.

Situations when consent is not required

Where a maker or person represented requires emergency health care, a health-care provider is not required to obtain consent from the delegate or statutory decision-maker if:

  1. the medical treatment is necessary to preserve the life or health of the maker or person represented;
  2. the delay involved in obtaining consent from the delegate or statutory decision-maker may pose a significant risk to the maker or person represented; and
  3. there is no information available that makes it clear that the maker or person represented would not want the required treatment.

Alternatives to a Personal Directive

Nothing in the Act precludes combining a personal directive with an enduring power of attorney made under the Powers of Attorney Act into a single document provided that the document conforms to the form and execution requirements of the Act.

The document authorizing a person to make personal-care decisions on behalf of another or setting out instructions, values, beliefs or wishes regarding personal care made outside of Nova Scotia has the same effect as a personal directive made under this Act if it was made either in the form required in Nova Scotia or in the jurisdiction outside of Nova Scotia.

Assessment of Capacity

According to the Regulations, only a physician may conduct the assessments or reassessment of capacity. RNs assess a client’s ability to consent to day-to-day services in relation to the provision of health care services. This basic assessment falls within the scope of practice of many health care professionals. Health care agencies must develop clear policies and procedures as to how to initiate a capacity assessment or reassessment by the physician.

Resource Links:

Personal Health Information Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Personal Health Information Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Define the term personal health information (PHI) as determined by this Act
  • Explain when a custodian may:
    • collect, use or disclose information without the consent of the individual
    • disclose personal health information about an individual to another custodian involved in the individual’s health care
    • Disclose personal health information without the individual’s consent
    • Disclose personal health information about an individual who is deceased
    • Disclose personal health information about an individual collected in the province to a person outside the province
  • State when the custodian reports a privacy breach
  • Identify when a person may request access to their PHI
  • Explain when a custodian may refuse to grant access to an individual’s personal health information
  • Explain when an individual may correct a record of information
  • Identify when a person is guilty of an offence in relation to the Personal Health Information Act

Synopsis of Information

The Personal Health Information Act defines the following terms: 

Personal health information means identifying information about an individual, whether living or deceased, and in both recorded and unrecorded forms, if the information:

  1. relates to the physical or mental health of the individual, including information that consists of the health history of the individual’s family,
  2. relates to the application, assessment, eligibility and provision of health care to the individual, including the identification of a person as a provider of health care to the individual,
  3. relates to payments or eligibility for health care in respect of the individual,
  4. relates to the donation by the individual of any body part or bodily substance of the individual or is derived from the testing or examination of any such body part or bodily substance,
  5. is the individual’s registration information, including the individual’s health card number, or
  6. identifies an individual’s substitute decision-maker. 

Custodian means an individual or organization described below who has custody or control of personal health information as a result of or in connection with performing the person’s or organization’s powers or duties:

  1. a regulated health professional or a person who operates a group practice of regulated health professionals,
  2. the Minister and the Department,
  3. the Minister of Health Promotion and Protection and the Department of Health Promotion and Protection,
  4. the Chief Medical Examiner pursuant to the Fatality Investigations Act,
  5. the district health authority pursuant to the Health Authorities Act,
  6. the IWK Health Centre pursuant to the Izaak Walton Killam Health Centre Act,
  7. the Review Board pursuant to the Involuntary Psychiatric Treatment Act,
  8. a pharmacy licensed under the Pharmacy Act,
  9. a continuing-care facility licensed by the Department under the Homes for Special Care Act or a continuing-care facility approved by the Department,
  10. Canadian Blood Services,
  11. any other individual or organization or class of individual or class of organization as prescribed by regulation as a custodian.

Agent is a person who, with the authorization of the custodian, acts for or on behalf of the custodian in respect of personal health information for the purposes of the custodian, and not the agent’s purposes, whether or not the agent has the authority to bind the custodian, is paid by the custodian or is being remunerated by the custodian, and includes, but is not limited to, an employee of a custodian or a volunteer who deals with personal health information, a custodian’s insurer or a lawyer retained by the custodian’s insurer. 

Circle of Care is defined as individuals and activities related to the care and treatment of a patient. This definition covers health care providers who deliver care and services for the primary therapeutic benefit of the client and it covers related activities such as laboratory work and professional consultation with other health care providers.  This definition also allows custodians to assume an individual’s knowledgeable implied consent to collect, use or disclose personal health information for the purpose of providing health care (Personal Health Information Act Toolkit – chapter 4) 

Collection, Use and Disclosure of Personal Health Information 

Collection of PHI

  1. A custodian is responsible for personal health information in the custody or control of the custodian and may permit the custodian’s agent to collect, use, disclose, retain or dispose of personal health information on the custodian’s behalf only if:
    1. the custodian is permitted or required to collect, use, disclose, retain or dispose of the information, as the case may be;
    2. the collection, use, disclosure, retention or disposition of the information, as the case may be, is in the course of the agent’s duties and not contrary to the limits imposed by the custodian, this Act or another law; and
    3. the prescribed requirements, if any, are met.
  2. Except as permitted or required by law and subject to the exceptions and additional requirements, if any, that are prescribed, an agent of a custodian shall not collect, use, disclose, retain or dispose of personal health information on the custodian’s behalf unless the custodian permits the agent to do so in accordance with subsection (1).
  3. An agent of a custodian shall notify the custodian at the first reasonable opportunity if personal health information handled by the agent on behalf of the custodian is stolen, lost or accessed by unauthorized persons. 

Disclosure of PHI to Other Healthcare Providers

A custodian may disclose personal health information about an individual to a custodian involved in the individual’s health care if the disclosure is reasonably necessary for the provision of health care to the individual. An example would be communication among healthcare providers involved in the individual’s circle of care as defined above. 

Collection and Disclosure of PHI without Consent

A provision in the Personal Health Information Act permits a custodian to disclose personal health information about an individual without the consent of the individual if required to do so by law.

The Act permits a custodian to disclose personal health information without the individual’s consent in the following circumstances:

  1. to another custodian if the custodian disclosing the information has a reasonable expectation that the disclosure will prevent or assist an investigation of fraud, limit abuse in the use of health services or prevent the commission of an offence under an enactment of a province or the Parliament of Canada;
  2. to persons acting on behalf of the individual including:
    1. a person who is legally entitled to make a health-care decision on behalf of the individual;
    2. a legal guardian, or
    3. the administrator of an estate, if the use or disclosure is for the purpose of the estate.
  3. to a regulated health profession body or a prescribed professional body that requires the information for the purpose of carrying out its duties in the Province under an Act of the Province or in another province of Canada under an Act of that province regulating the profession;
  4. to any person if the custodian believes, on reasonable grounds, that the disclosure will avert or minimize an imminent and significant danger to the health or safety of any person or class of persons;
  5. to an official of a correctional facility, as defined in the Correctional Services Act, or to an official of a penitentiary, as defined in the Corrections and Conditional Release Act (Canada) in which the individual is being lawfully detained if the purpose of the disclosure is to allow the provision of health care to the individual or to assist the correctional facility or penitentiary in making a decision concerning correctional services as defined in the Correctional Services Act or services provided under in the Corrections and Conditional Release Act (Canada);
  6. to another custodian for the purpose of ensuring quality or standards of care within a quality review program within the custodian’s organization;
  7. to the Minister of Health and Wellness for the purpose of planning and management of the health system;
  8. to the Nova Scotia Prescription Monitoring Board for monitoring prescriptions pursuant to the Prescription Monitoring Act; 
  9. to the Canadian Institute for Health Information to assist in the planning and management of the health system in accordance with the terms of an agreement between the Canadian Institute for Health Information and the Province;
  10. to a prescribed entity for the planning and management of the health system for all or part of the health system, including the delivery of services, if the entity meets the requirements of the Act;
  11. from the Province to another provincial or territorial government or the Government of Canada to assist in the planning and management of the health system;
  12. subject to the requirements and restrictions, if any, that are prescribed, if the disclosure is required or permitted by law or a treaty, agreement or arrangement made pursuant to this Act or another Act of the Province or the Parliament of Canada;
  13. to another custodian for the purpose of determining or verifying an individual’s eligibility for insured services;
  14. subject to the requirements and restrictions, if any, that are prescribed, to a person carrying out an inspection, investigation or similar procedure that is authorized by a warrant or by or under this Act or another Act of the Province or an Act of the Parliament of Canada for the purpose of complying with the warrant or for the purpose of facilitating the inspection, investigation or similar procedure;
  15. to a proposed litigation guardian or legal representative of the individual for the purpose of having the person appointed as such;
  16. to a litigation guardian or legal representative who is authorized under the Civil Procedure Rules, or by a court order, to commence, defend or continue a proceeding on behalf of the individual or to represent the individual in a proceeding;
  17. for the purpose of complying with:
    1. a summons, order or similar requirement issued in a proceeding by a person having jurisdiction to compel the production of information, or
    2. a procedural rule that relates to the production of information in a proceeding
  18. the disclosure is reasonably necessary for the administration of payments in connection with the provision of health care to the individual or for contractual or legal requirements in that connection;
  19. for the purpose of a proceeding or a contemplated proceeding in which the custodian or an agent or former agent of the custodian is, or is expected to be, a party or witness, if the information relates to or is a matter in issue in the proceeding or contemplated proceeding;
  20. for the purpose of risk management or patient safety within the custodian’s organization;
  21. to the Minister of Health and Wellness for the purpose of creating or maintaining an electronic health record.

The disclosure of health information without consent must be documented. The documentation must include a description or copy of the personal health information disclosed, the name of the person or organization to whom the personal health information was disclosed, the date of the disclosure and the authority for the disclosure.

Disclosure of PHI when Individual is Deceased

The Personal Health Information Act a custodian may disclose personal health information about an individual who is deceased or believed to be deceased:

  1. for the purpose of identifying the individual;
  2. for the purpose of informing any person whom it is reasonable to inform, the fact that the individual is deceased or believed to be deceased;
  3. to a spouse, parent, sibling or child of the individual if the recipients of the information reasonably require the information to make decisions about their own health care or the recipient’s children’s health care and it is not contrary to the express capable wishes of the individual; and
  4. for carrying out the deceased person’s wishes for the purpose of tissue or organ donation.

Where an individual is deceased, personal health information may be disclosed to:

  1. a family member of the individual; or
  2. to another person if the custodian has a reasonable belief that the person has a close personal relationship with the individual,

if the information relates to circumstances surrounding the death of the individual or to health care recently received by the individual and the disclosure is not contrary to the express capable wishes of the individual.

A custodian may disclose personal health information about a deceased individual if the disclosure is made after the earlier of:

  1. one hundred and twenty years after the record containing the information was created; and
  2. fifty years after the death of the individual to whom the personal health information relates,
  3. unless this Act otherwise permits the disclosure without the consent of the individual.

Disclosure of PHI outside the Province

A custodian may disclose personal health information about an individual collected in the Province to a person outside the Province but only where:

  1. the individual who is the subject of the information consents to the disclosure;
  2. the disclosure is permitted by this Act or the regulations;
  3. the disclosure is to a regulated health professional and the disclosure is to meet the functions of another jurisdiction’s prescription monitoring program;
  4. the following conditions are met:
    1. the disclosure is for the purpose of the planning and management of the health system or health administration,
    2. the information relates to health care provided in the Province to an individual who resides in another province of Canada, and
      • the disclosure is made to the government of that other province of Canada;
  5. the disclosure is reasonably necessary for the provision of health care to the individual and the individual has not expressly instructed the custodian not to make the disclosure; or
  6. the disclosure is reasonably necessary for the administration of payments in connection with the provision of health care to the individual or for contractual or legal requirements in that connection.

Where a custodian discloses personal health information about an individual under clause (e) above, and an express request of the individual who is the subject of the information prevents the custodian from disclosing all the personal health information that the custodian considers reasonably necessary to disclose for the provision of health care to the individual, the custodian shall notify the person to whom it makes disclosure of that fact. 

Reporting a Privacy Breach

A custodian that has custody or control of personal health information about an individual shall notify the individual at the first reasonable opportunity if the custodian believes on a reasonable basis that:

  1. the information is stolen, lost or subject to unauthorized access, use, disclosure, copying or modification; and
  2. as a result, there is potential for harm or embarrassment to the individual.

Prior to notification, a custodian may request authorization from the Privacy Review Officer to provide notification to the individual at a time other than the first reasonable opportunity, or in a manner other than direct contact with the individual.

Where a custodian determines that personal health information has been stolen, lost or subject to unauthorized access, use, disclosure, copying or modification, but it is unlikely that a breach of the personal health information has occurred or there is no potential for harm or embarrassment to the individual as a result, the custodian may decide that notification to the individual is not required. Where a custodian makes the decision not to notify an individual pursuant to this Section, the custodian shall notify the Privacy Review Officer as soon as possible. 

Individual’s Right to Access their PHI

An individual has a right of access to a record of personal health information that is in the custody or under the control of a custodian.

Custodian Refusal to Grant Access to PHI

A custodian may refuse to grant access to an individual’s personal health information about that individual if it is reasonable to believe that:

  1. the record or the information in the record is subject to a legal privilege that restricts disclosure of the record or the information, as the case may be, to the individual;
  2. another Act of the Province or of the Parliament of Canada or a court order prohibits disclosure to the individual of the record or the information in the record in the circumstances;
  3. the information in the record was collected or created primarily in anticipation of or use in a proceeding, and the proceeding, together with all appeals or processes resulting from it, have not been concluded;
  4. the following conditions are met:
    1. the information was collected or created in the course of an inspection, investigation or similar procedure authorized by law, or undertaken for the purpose of the detection, monitoring or prevention of an individual’s receiving or attempting to receive a service or benefit to which the person is not entitled under an Act of the Province or a program operated by the Minister, or a payment for such a service or benefit, and
    2. the inspection, investigation or similar procedure, together with all proceedings, appeals or processes resulting from them, have not been concluded;
  5. granting the access could reasonably be expected to result in a risk of serious harm to the treatment or recovery of the individual or a risk of serious harm to the mental or physical health of the individual;
  6. granting the access could reasonably be expected to result in a risk of serious harm to the mental or physical health of another individual; or
  7. granting the access could reasonably be expected to lead to the identification of a person who provided information in the record to the custodian in circumstances in which confidentiality was reasonably expected.

An individual has a right of access to that part of a record of personal health information about the individual that can reasonably be severed from the part of the record to which the individual does not have a right of access.

Where a record is contains more than personal health information about the individual, the individual only has a right of access to PHI that applies to them.

 Correction of PHI

Where the individual believes that the record is not accurate, complete or up-to-date, the individual may request in writing that the custodian correct the record. The individual can make an oral request to correct the record.

The individual must demonstrate, to the satisfaction of the custodian, that the record is not complete, accurate or up-to-date and gives the custodian the information necessary to correct the record. A custodian is not required to correct a record of personal health information if it was not originally created by the custodian and the custodian does not have sufficient knowledge, expertise and authority to correct the record; or it consists of a professional opinion or observation that a custodian has made in good faith about the individual.

Offences under the PHI Act

A person is guilty of an offence if the individual:

  1. willfully collects, uses or discloses health information in contravention of this Act or the regulations
  2. willfully gains or attempts to gain access to health information in contravention of this Act or the regulations
  3. willfully obtains or attempts to obtain another individual’s personal health information by falsely representing that the person is entitled to the information
  4. fail to protect personal health information in a secure manner
  5. in connection with the collection, use or disclosure of personal health information or access to a record of personal health information, makes an assertion, knowing that it is untrue, to the effect that the person is a person who is entitled to consent on behalf of another individual
  6. willfully disposes of a record of personal health information in contravention of the requirements for protection of personal health information required in this Act or the regulations
  7. requires production of or collects or uses another person’s health card number in contravention of this Act or the regulations
  8. willfully alters, falsifies, conceals, destroys or erases any record, or directs another person to do so, with the intent to evade a request for access to the record
  9. willfully obstructs, makes a false statement to, or misleads or attempts to mislead the Privacy Review Officer or another person in the performance of the duties, powers or functions of the Privacy Review Officer under this Act
  10. willfully obstructs, makes a false statement to, or misleads or attempts to mislead another individual or organization in the performance of the duties, powers or functions of that individual or organization under this Act
  11. uses individually identifying health information to market any service for a commercial purpose or to solicit money unless the individual who is the subject of the health information has expressly consented to its use for that purpose
  12. discloses personal health information contrary to this Act with the intent to obtain a monetary or other material benefit or to confer such a benefit on another person
  13. breaches the terms and conditions of an agreement entered into with a custodian under this Act.

Resource Links:

Pharmacy Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Pharmacy Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Define the terms alternative practice, compounding, dispense, dispensing, and hospital pharmacy
  • Identify which health professionals have the authority to compound and dispense drugs
  • Identify when pharmacists may prescribe drugs
  • Identify when a pharmacist can directly administer drug therapy to patients

Synopsis of Information 

Definitions 

Alternative practice means the authority for a registrant to lawfully carry out services more usually provided by other health professionals.

Compounding means the pharmaceutical preparation of two or more ingredients, at least one of which is a drug, into a drug product.

Dispense means the process of completing a prescription including its release to the patient.

Dispensing is defined as “the interpretation, evaluation and implementation of a prescription drug order, including the preparation and delivery of a drug or device or patient’s agent in a suitable container appropriately labeled for subsequent administration to, or use by, a patient” (NAPRA, 2009) and, in Nova Scotia, it is to be performed by a pharmacist.

Hospital pharmacy means a pharmacy within the care and jurisdiction of a hospital as defined by the Hospitals Act that (i) dispenses drugs to patients in the hospital for treatment and to registered outpatients for administration within the jurisdiction of the hospital, including dispensing drugs in small quantities to a discharged patient or emergency outpatient to serve the patient until the patient can obtain medication from a community pharmacy and for patients on pass or other short leaves of absence, and (ii) does not dispense drugs to the general public, to hospital staff or to others outside the care and jurisdiction of the hospital.

Compounding and Dispensing Authority

Compounding and dispensing medications are not within the scope of practice of registered nurses, but only within the scope of practice of pharmacists. Compounding may be done to meet the unique needs of a client. For example, mixing a drug when a required dosage is not available commercially; changing the form of a drug from pill to liquid; or removing a non-essential ingredient from a drug to which a client is allergic.

It is not considered compounding when registered nurses for example, crush medications to administer via a nasogastric tube or reconstitute medications for parenteral administration or mix two different types of insulin in the same syringe.

According to the Medication Guidelines, the repackaging or providing of medications to clients, after they have been dispensed by a pharmacy should be referred to as ‘supplying’ not dispensing a medication.

Other situations that are often incorrectly referred to as dispensing include:

  • filling a mechanical aid or alternative container from a client’s own blister pack or prescription bottle, to facilitate self-administration or administration by a caregiver
  • repackaging and labeling drugs from a client’s own supplies
  • administering medications prepared by a pharmacy
  • administering medications from a stock supply (dispensed by pharmacy)
  • providing clients with their own blister packs or prescription bottles
  • providing clients with medications obtained from a ward stock or ‘night cupboard’
  • providing clients with medications previously dispensed to a stock supply, to cover them at discharge until they can get their prescriptions filled by their local pharmacies (when continuity of medication therapy is essential)
  • having an agency pharmacy fill a prescription upon a client’s discharge and providing these medications to the client because s/he will be unable to get the required medications from her/his community pharmacy.

Pharmacists’ Prescriptive Authority

A pharmacist may prescribe:

  1. Schedule II or Schedule III drugs under these regulations to treat a condition.
  2. Schedule I drugs under these regulations in accordance with the standards of practice to treat conditions approved by the Council.
  3. Any drugs under these regulations in any of the following circumstances to maintain or enhance patient care:
    1. under conditional authority in accordance with the Registration, Licensing and Professional Accountability Regulations made under the Act;
    2. to provide or replace a supply, or a portion of a supply, of prescription drugs in an emergency, as determined by Council;
    3. to renew an existing prescription;
    4. to adapt an existing prescription by modifying any of the following:
      1. the dose of the drug,
      2. the formulation of the drug,
      3. the regimen for the drug,
      4. how long the drug is to be taken;
    5. to substitute a drug with another in the same therapeutic class;
    6. in a practice setting approved by Council—such as a hospital, a home for special care or a multi-disciplinary environment—where collaborative relationships or appropriate protocols are established;
    7. in emergency circumstances identified by the Council to be in the public interest

Pharmacists’ Authority to Directly Administer Drugs to Patients

Subject to any requirements set out in the regulations, a pharmacist who has any additional qualifications set out in the regulations may:

(a) prescribe drugs and treatments;

(b) order, receive, conduct and interpret tests and services needed to properly manage drug therapy;

(c) directly administer drug therapy to patients; and

(d) engage in collaborative or alternative practice.

Resource Links:

Protection for Persons in Care Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Protection for Persons in Care Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Define the terms  abuse and health facility
  • Explain the duties of a service provider who suspects client abuse
  • List the powers of the Investigator in cases of reported abuse
  • Identify when a Minister may refer the matter of abuse to a regulatory body 

Synopsis of Information

Definitions 

Abuse means, with respect to adult patients or residents, any of the following (Protection for Persons in Care Regulations:

  1. the use of physical force resulting in pain, discomfort or injury, including slapping, hitting, beating, burning, rough handling, tying up or binding;
  2. mistreatment causing emotional harm, including threatening, intimidating, humiliating, harassing, coercing or restricting from appropriate social contact;
  3. the administration, withholding or prescribing of medication for inappropriate purposes;
  4. sexual contact, activity or behaviour between a service provider and a patient or resident;
  5. non-consensual sexual contact, activity or behaviour between patients or residents;
  6. the misappropriation or improper or illegal conversion of money or other valuable possessions;
  7. failure to provide adequate nutrition, care, medical attention or necessities of life without valid consent.

“Abuse” does not occur in situations in which

  1. a service provider carried out their duties in accordance with professional standards and practices and health-facility-based policies and procedures; or
  2. a resident or patient who has a pattern of behaviour or a range of behaviours that include unwanted physical contact uses physical force against another patient or resident which does not result in serious physical harm, and the service provider has established a case plan to correct these behaviours.

Health facility means (Protection for Persons in Care Act:

  1. a hospital under the Hospitals Act,
  2. a residential care facility, nursing home or home for the aged or disabled persons under the Homes for Special Care Act, or
  3. an institution or organization designated as a health facility by the regulations;

Duties of a Service Provider who Suspects Abuse

As a service provider, and RN, who has a reasonable belief that a patient or resident is, or is likely to be abused shall promptly report the belief, and the information on which it is based, to the facility administrator, which must then be reported to the Minister or the Minister’s delegate by the facility administrator. The duty to report applies even if the information on which the person’s belief is based is confidential and its disclosure is restricted by legislation or otherwise. Duty to report does not apply to information that is privileged because of a solicitor-client relationship.

Powers of the Investigator

An investigator may enter a health facility at any reasonable time, on presenting identification when requested to do so. An investigator may require any person who is able, in the investigator’s opinion, to give information about a matter being investigated.

Minister’s Report of Abuse to a Regulatory Body

The Minister may refer the matter to the body or person that governs the person’s professional status or that certifies, licenses or otherwise authorizes or permits the person to carry on the person’s work, profession or occupation.

Resource Links:

Freedom of Information and Protection of Privacy Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Freedom of Information and Protection of Privacy Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Define personal information
  • Identify the purpose of the Freedom of Information and Protection of Privacy Act
  • Identify when disclosure of personal information is permissible 

Synopsis of Information 

Definitions 

Personal information (Freedom of Information and Protection of Privacy Act means recorded information about an identifiable individual, including:

(i) the individual’s name, address or telephone number,

(ii) the individual’s race, national or ethnic origin, colour, or religious or political beliefs or associations,

(iii) the individual’s age, sex, sexual orientation, marital status or family status,

(iv) an identifying number, symbol or other particular assigned to the individual,

(v) the individual’s fingerprints, blood type or inheritable characteristics,

(vi) information about the individual’s health-care history, including a physical or mental disability,

(vii) information about the individual’s educational, financial, criminal or employment history,

(viii) anyone else’s opinions about the individual,

and

(ix) the individual’s personal views or opinions, except if they are about someone else.

Purpose of the Freedom of Information and Protection of Privacy Act

The purpose of this Act is:

(a) to ensure that public bodies are fully accountable to the public by

  1. giving the public a right of access to records,
  2. giving individuals a right of access to, and a right to correction of, personal information about themselves,
  3. specifying limited exceptions to the rights of access,
  4. preventing the unauthorized collection, use or disclosure of personal information by public bodies, and
  5. providing for an independent review of decisions made pursuant to this Act; and

(b) to provide for the disclosure of all government information with necessary exemptions, that are limited and specific, in order to

  1. facilitate informed public participation in policy formulation,
  2. ensure fairness in government decision-making,
  3. permit the airing and reconciliation of divergent views;

(c) to protect the privacy of individuals with respect to personal information about themselves held by public bodies and to provide individuals with a right of access to that information.

Disclosure of Personal Information

Disclosure of personal information is not an unreasonable invasion of a third party’s personal privacy if:

(a) the third party has, in writing, consented to or requested the disclosure;

(b) there are compelling circumstances affecting anyone’s health or safety;

(c) an enactment authorizes the disclosure; result in similar information no longer being supplied to the public body when it is in the public interest that similar information continue to be supplied,

(iii) result in undue financial loss or gain to any person or organization, or

(iv) reveal information supplied to, or the report of, an arbitrator, mediator, labour relations officer or other person or body appointed to resolve or inquire into a labour-relations dispute.

Resource Links:

Vital Statistics Act

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the Vital Statistics Act that directly governs nursing practice

Objectives – the registered nurse will:

  • Identify who can apply for a change in sex designation on their birth registration
  • Identify health professionals who are authorized to confirm a change in sex designation
  • Identify the RN’s responsibilities in responding to requests for a change of sex designation 

Synopsis of Information 

Some individuals identify with a gender that is not consistent with the sex noted on their birth registration forms. In the past, changing the sex designation of an individual’s birth registration to reflect their lived gender identity required the completion of sex reassignment surgery. Changes to the Nova Scotia Vital Statistics Act enable individuals to change the sex designation on their birth registration without having to undergo any surgical procedures. This change came into effect on September 22, 2015 and applies to individuals born in Nova Scotia.

Individuals who can apply for a Change of Sex Designation

Individuals 16 years of age or older who are seeking to change the sex designation on their birth certificate require a written statement from a physician, psychologist, nurse practitioner, registered nurse or social worker on their application to confirm that, in the provider’s opinion, the sex designation on the current birth registration does not correspond with the individual’s gender identity.

Only physicians and psychologists have the authority to sign the Change of Sex application package if the person seeking this change on their birth certificate is 15 years old or younger.

Health Professionals Authorized to Provide a Statement Supporting a Change of Sex Designation

Registered nurses, nurse practitioners, physicians, psychologists, and social workers can provide a statement supporting a client’s request for a change of sex designation.

RN Responsibilities in Provide a Statement Supporting a Change of Sex Designation

An RN can provide a statement supporting a change of sex designation as long as they practise in Nova Scotia or they practise in the province where the applicant currently lives.

The RN will need to have an open non-judgmental conversation with the individual making the request. The determination can be made if the individual indicates that their gender identity does not match the sex designation indicated on their birth certificate. Please note that your opinion is being sought as a member of a professional body and not as an expert in gender identity.

Within the Change of Sex application package, there is a written statement which indicates that in the RN’s opinion, the sex shown on the applicant’s birth registration does not correspond with the applicant’s gender identity and that the RN is in support of the applicant’s request to change the sex designation on their birth registration..

The request and outcome of the discussion between the client and RN should be documented in the client’s notes as per agency policy.

Resource Links:

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